Direct Screen Colonoscopy Questionnaire Form

Thank you for your interest in our Direct Screen Colonoscopy Program at SurgiCare of Miramar! Please also check your inbox for an email with the below information.

Please click below to download the Questionnaire Form to see if you would be a good candidate for our Direct Screen Colonoscopy Program. Once you have completed the form, please email the completed form to: Noelia Gutierrez ([email protected]). Once submitted, a member of our staff will get back to you shortly.